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  • About Us
    • Our Physicians
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  • Contact
  • Our Services & Treatments
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Vaginal Discharge- What's Going on Down There?!

9/27/2016

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Concern about vaginal discharge is one of the most common reasons women see their gynecologist. So, how do you know what’s normal, and what’s not?

Most vaginal discharge is fluid made by glands in the vagina and cervix.  This fluid carries away bacteria and dead cells and serves as an important housekeeping function of the female reproductive system.  Usually this fluid or discharge is completely normal and varies in color or quantity based on the time in your menstrual cycle when it is produced.  For example when you are ovulating, breastfeeding, pregnant or sexually aroused, you are more likely to notice increased vaginal discharge.  Most normal discharge is clear or white in color and may appear yellow when dried on your underwear.  

So when should you be worried and call your doctor?

Call your doctor if your discharge all of a sudden develops a strong fishy odor (insert your own joke here, although for women who experience this type of discharge, it’s no laughing matter).   Especially if this odor becomes more prominent with intercourse or after your menstrual cycle, you may have something called bacterial vaginosis.  Often women notice this after a course of antibiotics. Bacterial vaginosis is not a sexually transmitted disease but rather a disruption in the normal vaginal flora.  This can be easily treated with a course of antibiotics. 

Does it itch so much that you can't stop scratching and you look like you have ants in your pants? This may be a yeast infection, but check with your doctor first.  Yeast infections can follow a course of antibiotics and are more common in pregnancy and women with diabetes.  A yeast infection is not a sexually transmitted disease and can usually be treated with a course of anti fungal medications that comes in a pill or vaginal cream form, although generally we suggest you try the cream first during pregnancy, as diflucan (the pill) has been associated with birth defects at high doses. 

If you have new onset discharge and pelvic pain, especially if you also have a fever or a new sexual partner, then you should notify your doctor right away.  Heavy vaginal discharge associated with pelvic pain could be concerning for a sexually transmitted disease like gonorrhea, chlamydia, trichomoniasis and/or pelvic inflammatory disease.  If you are concerned about a sexually transmitted disease, you should have an evaluation immediately because long term exposure to an STD like gonorrhea or chlamydia can cause infertility by scarring your fallopian tubes. 

Also remember to avoid heavily perfumed soaps or lotions which can contribute to vaginal irritation and abnormal discharge.  Douching can also contribute to abnormal vaginal discharge by destroying the healthy bacteria in the vagina.  If you are hypersensitive, then be careful about the type of laundry detergent and the kind underwear you choose- tight clothing, thongs and certain materials (non cotton) can contribute to irritation/ discomfort in the vaginal area.  

Ultimately, all women have vaginal discharge, but if you sense something abnormal down there and are not sure, you should visit your doctor. Remember your vaginal health is important!

Pam
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Diastasis recti:  I already had my baby, why do I still look pregnant?

9/20/2016

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What is Diastasis recti? Diastasis recti is when the space between your left and right abdominal muscles widens and your belly sticks out- what is so eloquently referred to as a "pooch".   During pregnancy your growing uterus will put so much pressure on your belly that your abdominal muscles will move aside and your bowels and other organs only have a thin band of connective tissue, the linea alba, to hold them in place.  About 2/3 of pregnant women have this condition.  Once you have delivered your baby, the thinning of the linea alba generally improves; however, for many women the connective tissue gets so stretched out during pregnancy that it looses its elasticity and is unable to retract back into position.  Particularly if you have had multiple pregnancies.

Who is at risk of developing diastasis recti during pregnancy?  You are more likely to get it if you are older than 35 while pregnant, are petite, have poor muscle tone, are pregnant with twins or are carrying a large baby (thank you, my little chubster baby).  Women who have had a diastasis in a previous pregnancy are more likely to get a diastasis in a subsequent pregnancy as well.  Women with a history of umbilical or ventral hernia are at greater risk of developing it as well.

Can I prevent it? The best way to prevent it is to have strong core strength prior to pregnancy (1,000 situps per day should do it..just kidding, there are some great guides online, though, including at Mayo Clinic).  During pregnancy try to stay active. Don't strain while pregnant: constipation and lifting heavy things can cause strain on the linea alba and make the gap between your abdominal muscles worse.  It doesn’t mean you can’t work out while pregnant, but it’s probably not the time to lift 500 lbs over your head either.

How do I know if I have it?  Your doctor can diagnose diastasis with ultrasound or by measuring how far apart your abdominal muscles have separated with measuring tape or more commonly with finger lengths.  Most patients can also perform a self test: lie on your back with your knees bent and place one hand at your navel and bring your head up into a crunch like position and you should be able to feel the sides of your rectus abdominus muscles and feel how far apart they are separated. Normally, the separation is less than 2.7cm, or not much over an inch.  There are some videos online demonstrating this technique.

​How can I treat it?  Restrengthening your core and resuming cardiovascular exercise postpartum should help.  Make sure you get the green light from your doctor before resuming your exercise routine.  However, for a lot of women they are unable to regain the elasticity of their connective tissue and so despite how hard they work out they are unable to get rid of that pooch”- for these women diastasis may only be corrected with surgery- a tummy tuck, often with excess skin removal.  If you are considering surgery, please wait until you are done having children, otherwise, the diastasis may (will probably) return.  

In general, time and resumption of exercise can make a big difference, especially if you worked those muscles going into pregnancy, but if you feel like the symptoms are persistent despite your conservative measures, then you can discuss referral for surgery with your doctor.  Just remember that in order to have the best results, the gap should generally be wider than two fingers, childbearing should be completed, and you will have to devote adequate time to the recovery process.

Pam


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Women’s Sexual Health

9/13/2016

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Now that I have your attention, let us explore this interesting subject.  I’d like to focus this discussion on the issue of sexual dysfunction (sex is not what you would like it to be for one or more reasons).  There are many components that contribute to this problem.  Some of these can be related to the relationship; some related to physical causes, some have to do with traumatic events in a woman’s past such as a rape or assault.   The most important thing for you to remember is that there is help for you whatever the reasons are.  Sometimes you can discuss these with your partner, and sometimes that is not an option.  The topic of sexuality can be a hard one to initiate, regardless of who you are trying to ask for help.  A good option would be to discuss your concerns with your GYN provider.  Let’s talk about some things that might help you broach the subject if they don’t ask you first.  A few of the sexual dysfunction disorders are listed below.   Hopefully if any of these ring a bell with you, I want to encourage you to ask your GYN provider about it.  There are ways of helping you and your partner work through these concerns.  You deserve that help.  

For those affected with Female Orgasmic Disorder, it would affect 75-100% of occasions of sexual activity.  It consists of marked delay in, marked infrequency of, or absence of orgasm, markedly decreased intensity of orgasmic sensations, and it causes marked distress or interpersonal difficulty.

Sexual Interest/Arousal disorder would be of at least 6 months duration and have any 3 of these indicators, which may include absent/reduced frequency or intensity of interest in sexual activity, sexual/erotic thought or fantasies, or initiation of sexual activity. The patient is typically unreceptive to a partners attempt to initiate intercourse, notes decreased sexual excitement/pleasure, and may have reduced genital and/or nongenital sensations.  It must also cause marked distress or interpersonal difficulty.


Genito-Pevic Pain/Penetration Disorder can be lifelong or acquired (maybe related to one partner and not another, or didn’t use to be a problem with this partner and now it is), and can be mild to severe in nature. Symptoms have persisted for more than 6 months.  It involves persistent or recurrent problems with one or more of the following: vaginal penetration during intercourse, marked vulvovaginal (pain outside or inside the vagina) or pelvic pain during intercourse or attempted penetration, marked fear or anxiety about penetration, or muscles of the pelvis tighten just anticipating penetration.  


Some sexual concerns are more common at different stages of life; initiation of sexual activity, physical changes related to different types of birth control, postpartum and menopause changes, which can affect you both physically and emotionally. There are changes and adjustments that come with a severe injury or a major disease process such as cancer. These are just a few of the issues that may be causing you concern, and there are many more that we could talk about.  


There is now a drug approved for the treatment of female sexual desire disorder, but before that is prescribed for you it is important that you discuss your situation thoroughly with your care provider.  Not everything is fixed with a prescription.  Sometimes you may need someone that can describe the wide range of normal  anatomy to you, sometimes  information is the best, sometimes specific suggestions are helpful.  There are lots of books and videos that are educational that we can recommend.  There is information about personal lubricants, which are ok for use in the vagina, but options some may not be safe for you.  You may need to be evaluated for an infection or with an ultrasound to assess pain if that is a part of your concern. 

The bottom line is to talk with your GYN provider about your concerns, and together you can develop a plan to help improve your concerns.  A healthy sex life is important to your quality of life.  Share your concerns and get the help you deserve.  Thanks for reading!


Margaret Leverett, WHNP-BC

2305 Coronado
Idaho Falls, ID 83404
208-535-9009

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You’re Taking a Culture from Where?! An Overview of Group B Strep and Why We Care About It

9/6/2016

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What is group B strep (GBS)?  This bacterium is part of the normal flora (usual bacteria) of between 10-30% of all women and can be found in the digestive, urinary and reproductive tracts.  GBS is generally not harmful to those who carry it, nor is it an STD.    It’s kind of like the difference between having blue eyes and brown eyes.  Also of note, it’s different than group A strep that causes “strep throat.”

When and how do we test for it?  Because the bacteria that make up a woman’s normal flora can change over time, we test using vaginal and, yep, rectal cultures to assess for colonization (carrying the bacteria without ill effects) between 35-37 weeks of pregnancy. The exception may include testing sooner if preterm delivery seems likely, and the test results are valid for up to 6 weeks.

So, if this isn’t harmful to me, why are you sticking a cotton swab up there and especially back there?!  Unfortunately, while GBS colonization is generally not harmful to mom, it can cause infection within the uterus and be passed to her baby, where it can cause a serious infection.  GBS is the leading cause of sepsis (blood infection) and meningitis (nervous system infection) in newborns.

What happens if my baby is exposed to GBS?  There are two types of infections in babies: early-onset infections, which happen in the first 24-48 hours after delivery, and late-onset infections, which may occur even after the first 6 days of life.  Early-onset infections are generally caused by GBS exposure in the birth canal, and certain risk factors, such as preterm birth, prolonged rupture of membranes (time after the bag of water ruptures), increase the risk of infection.  The most common problems seen with early-onset GBS infection are lung infections, blood infections (sepsis), and meningitis.  Late-onset GBS infections occur after the first 6 days of life. These may either be passed by maternal handling (if she is colonized) or other contact with colonized persons.  Late-onset GBS infections can also contribute to meningitis and pneumonia.

How do I prevent infection in my baby?  If the vaginal/rectal culture results are positive during the current pregnancy, if you’ve had a urine culture showing GBS infection earlier in the pregnancy or if you’ve had a previous baby infected with GBS, then the recommendation is for IV antibiotics during labor.  If we try to treat GBS prior to labor, it may just grow back by the time your baby comes.  Penicillin is the treatment of choice, although if allergic, then other antibiotics can be used, depending on the severity of the allergy.  Antibiotics result in an 80% reduction in transmission to a newborn whose mother is colonized with GBS (the biggest risk for having an infected infant).

Does everyone have to be tested, I’m having a scheduled cesarean section?  The recommendation is to test all woman between 35-37 weeks (or a few weeks prior to planned delivery), except those who have had a previous child with GBS infection or those with a GBS urinary tract infection during this pregnancy, as those woman require treatment regardless of any future culture results.  Even those undergoing scheduled cesarean delivery still benefit from testing because if their amniotic sac (bag of water) breaks prior to their planned delivery and they are GBS positive, then their baby will need to be monitored closely for development of symptoms.

How do I know if my baby has a GBS infection?  After receiving antibiotics, the chance of early-onset infection is significantly reduced, although late-onset infection is still possible.  Some signs that may indicate infection in the newborn are slowness/inactivity, irritability, poor feeding, vomiting and high fever; however, while it is important to mention to your pediatrician, just because your baby has one of these symptoms doesn’t necessarily mean your infant has been infected.  Believe me, not every irritable infant has GBS :)

So, in case you were wondering why we bother with rectal and vaginal cultures, it’s to determine if your child is at risk for developing complications from a highly preventable infection.  Even though it can be a little uncomfortable, it’s totally worth it for a healthy new baby :)

​Nick
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